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Instituto Nacional de Neurología y Neurocirugía

2013, Number 2

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Arch Neurocien 2013; 18 (2)

Cost-effectiveness evaluation of olanzapine/fluoxetine 6/25 mg combination in the management of depressive episodes associated with bipolar disorders

Vargas-Valencia J, Ramírez-Gámez J, Ruiz-López I, González-de Castilla A

Language: English
References: 39
Page: 69-77
PDF size: 338.20 Kb.


ABSTRACT

Bipolar disorder (BD) is a chronic mental disorder characterized by the presence of a major depressive episode in patients with a histor y of at least one episode of mania or hypomania. According to the diagnostic and statistical manual of mental disorders fourth edition (DSM-IV), BD is divided into type I and type II bipolar disorder, cyclothymia and bipolar disorder not other wise specified. This affective disorder is one of the most frequently found mental diseases worldwide. Its high prevalence constitutes a real public health problem due to the high risk of suicide (17- 19%) during the depressive phase which is associated with high morbidity. This suicide rate is 15 to 20 times greater than the rates reported for the general population. Different pharmacological alternatives have been evaluated for the treatment of the acute depressive phase of type I bipolar disorder, including lamotrigina (LTG), litheum (LI), quetiapine (QTP) and a fixed combination of 6mg of olanzapine plus 25mg of fluoxetine (OFC, 6/25mg). Although most of these alternatives are the treatment of choice for a majority of published treatment guidelines, some have not been approved by Mexican Ministr y of Health (SSA) in Mexico or by the Food and Drug Administration (FDA) in the United States. The present analysis was performed with the aim of evaluating the cost-effectiveness relationship of OFC compared to LTG, LI and QTP in the management of depressive episodes associated with type I bipolar disorder. For this analysis, a decision-tree chart was designed based on the international treatment algorithms. For the economic analysis, we made an adaptation of the CANMAT treatment guidelines algorithm that proposes OFC or LTG, LI and QTP monotherapies as first line treatments. The efficacy of each treatment was obtained from the values reported by Vieta 2010 in a meta-analysis of randomized, double-blind, placebo controlled trials that used a ≥ 50% reduction on the Montgomer y-Asberg Depression Rating Scale (MADRS) compared to baseline scores as primar y outcome. The results suggest that the use of OFC in one capsule is a cost-effective alternative when compared to LTG and LI and a dominant alternative when compared to QTP during a 38-week period if hospitalization costs are not considered (first treatment strategy). Patients not showing an adequate treatment response were placed in the second treatment strategy group, which includes hospitalization costs during 17 days in the 46-week period. For the second strategy, OFC proved to be a dominant option when compared to LTG, LI and QTP.


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